The Gut – Health Connection

There’s no doubt about it. Most of our health problems start in our gut. You see, our digestive system does much more than just help us to digest and eliminate food – though those are important functions, too. Our gut, through our microbiome, the unique collection of gut flora that inhabits our intestines, influences our immunity, mental health, detoxification, and hormones. The lining of our gut is a major protective barrier between the foods we eat and microorganisms to which we are exposed, and our immune system, which influences our reactions to foods, and whether we develop food sensitivities, inflammatory conditions, and chronic diseases.


What is Leaky Gut Syndrome (LGS)?

Your gut is lined with a row of cells called enterocytes. Between these cells are tight junctions. Their job is to regulate what gets across the intestinal lining and into your general system. While the gut is naturally permeable to nutrients, which are small molecules, so that you can get your nutrition from your food, when your gut barrier and microbiome get weakened from chronic exposure to foods and medications that irritate your gut, or when the good bacteria get out of balance from antibiotics, these tight junctions develop gaps, and you can develop a leaky gut, or leaky gut syndrome (LGS). When this happens, fragments of protein and bacteria that aren’t supposed to can get into your system. Your body recognizes these are foreign invaders and responds by producing antibodies that mount an immune system reaction against these molecules. Your body goes on red alert to react to many triggers in your environment.

10 Signs That You Have a Leaky Gut

1. You struggle with digestive problems including gas, bloating, loose stools, or irritable bowel syndrome (IBS).

1. You have food intolerances or food sensitivities.

2. You suffer from seasonal allergies.

3. You have eczema, skin rashes, acne, or other chronic skin problems.

4. You have an autoimmune condition.

5. You’re tired all the time.

6. You have chronic fatigue syndrome or fibromyalgia.

6. You struggle with anxiety, depression, or erratic moods.

7. You’ve been diagnosed with yeast (Candida) overgrowth or SIBO (small intestinal bacterial overgrowth).

8. You can’t lose weight in spite of an excellent diet.

9. Your joints ache and swell.

10. You have trouble concentrating, with your memory, or notice other cognitive changes.

How to Heal Your Leaky Gut

Healing your gut is not hard to do, and it is the most important first step in treating most chronic conditions. 

To simplify the process of healing the gut, I teach my patients the 4R program. Depending on the severity of your symptoms, it can take from about 4-6 weeks to 6 months to fully heal your gut. Symptom improvement is your best guide to resolution. 


1. Remove : Take out what ails you. Start with an Elimination Diet for 2 weeks. Remove all of the triggers that irritate your gut including foods, medications (of course check with your doctor on this), and ideally, stress, too!  If you have been diagnosed with Candida (yeast) in the past, or have a lot of gas, bloating, and either loose stools or constipation, you might want to do this phase in conjunction with a functional medicine doctor who can provide comprehensive stool testing to see if this is still a problem and who can work with you on supplements (or sometimes medications), to eliminate the yeast overgrowth. 

2. Replace: Add in digestive support. This includes digestive enzymes, and if you have a lot of nausea with meals or when you take supplements, you might also need some additional stomach acid in the form of  a supplement called Betaine HCl, or  try 1 Tbs. of apple cider vinegar in water with your meals. 

3. Reinoculate:  Add in a good quality probiotic to restore your gut flora. You want it to have a minimum of 5 billion CFUs in each dose, and a good range of Lactobacillus and Bifidobacter species. Fermented foods such as miso, sauerkraut, kombucha, and kimchee can also be helpful. 

4. Repair: The following supplements can be taken for up to 6 months to help to heal the intestinal lining:

  • Tumeric, aloe vera, marshmallow root, and DGL licorice (aloe and licorice are not for internal use during pregnancy; these are fine for children) are some of the most effective herbs for healing the gut lining. They are best taken in capsule or extract form, though tumeric can also be added to foods. DGL licorice is available as chewable lozenges and thus may be the simplest one to give to kids.
  • Zinc: 5-10 mg/day for children 4-7 years, 10-20 mg/day for children to age 12, 25-40 mg/day for older children and adults
  • An antioxidant supplement containing vitamins A and carotenoids, C, E, and selenium. These are often found in a multivitamin. Pregnant women should get these from their prenatal vitamin only.
  • Fish oil: I prefer Nordic Natural Pro-EFA Junior for kids, and any good quality fish oil for adults. For kids you can put the oil into smoothies. Fish oil is important for general health in pregnancy and breastfeeding, too.
  • L-Glutamine Powder: 5-10 gm of powder twice daily for one month. (Much less for kids but talk with your child’s doctor before using and don’t supplement in pregnancy).

Doing the 4R program, especially following an elimination diet, can help you to heal many of  your symptoms and conditions – 4Ever.

To your health!



  1. What is the timeline of the 4R? After two weeks, do you start re-introducing foods? Or do you only start with enzymes, probiotics and herbs? Do you start those all at the same time? Or one after the other?
    Thank you!

    • Anywhere from 4 weeks for many months, depending on the severity of the condition. I start with phase 1 usually, then move along the R’s in order, though in some patients, I may start several levels at once….Best wishes!

      • Hi there I have very severe psoriasis and digestion issues however I am vegan eat very healthy and exercise 5 days a week and can’t loose weight!!! I have had psoriasis for over 15 years I am 37 and as a child was given a lot of antibiotics with no probiotics, can you help me with how long in each phase to do the 4R or should I do all the phases together! I pretty much know what foods cause sensitivities and avoid them most of the time. Should I have any tests done!! I answered yes to almost all the signs above for LGS!

        • Hi Lynn,

          Thank you for your comment and the short answer is yes, working with either an integrative or functional doctor is going to help you to get to the root of what specifically is going on with your system.

          Warm wishes,
          Megan- Aviva Romm’s Executive Assistant and Online Nutrition Expert

        • Hi Lynn,

          I’m suffering from Psoriasis, too. Now I’m reading the Book “Healing Psoriasis” (Pagano) and I’m so grateful that I’ve found it. Pagano developed a diet and it works! I don’t need my cortisone ointment anymore! You can read a lot of comments of other content patients on amazon…

          Good luck and remain hopeful!

  2. I want to add, I found this online, about glutamine.
    “Monosodium glutamate (MSG) sensitivity (also known as “Chinese restaurant syndrome”): If you are sensitive to MSG, you might also be sensitive to glutamine, because the body converts glutamine to glutamate.”
    I am sensitive to MSG, I have avoided for years.

    • Angie, thank you for your comment here. I was taking glutamine and it made me tremendously sick. I thought I was healing my gut and it was getting worse and worse. Yes, I too have a sensiivity to MSG and have since learned that there are certain foods I must avoid. Sometimes it seems as if each day is still a learning process as I’ve also learned that I cannot have anything with whey in it as it too is high in glutamates, which was also making me sicker instead of helping me feel better. Dr. Russell Blaylock talks about glutamates in great detail. Hopefully more health guru’s will learn about the dangers of glutamates and stop recommending products like glutamine which are actually harmful to health, not beneficial.

  3. Are you familiar with the GAPS diet for Leaky Gut? It seems extreme, but promises great benefits. I see that your diet recommendations are not so extreme. This seems much easier to try. What do you think of bone broth (the staple of the GAPS diet)?

    Also, your link to the Elimination Diet in step one seems to be broken.

    Thank you!

    • Yes – if a patient has very severe digestive problems, autoimmune disease, or environmental allergies, I will sometimes use a more restrictive diet. Often and extreme diet is not necessary – the key is identifying food triggers with an elimination diet and then keeping those foods out of the diet until either the gut has improved or indefinitely if the are major triggers (ie gluten in someone with celiac, dairy in someone with lactose intolerance). If am not a giant fan of bone broth. IF you do use it, make sure the bones are strictly from organically raised animals.

  4. Hi Aviva – you mention here avoiding L-Glutamine in pregnancy. I have a supplement I am taking to heal my gut that includes L-Glutamine. I am taking these steps because I’m planning on TTC soon and had planned to continue the supplement throughout my pregnancy. Can you explain why pregnant women shouldn’t take it, and point me to any research? Thank you so much!

    • The data on L-glutamine safety in pregnancy is insufficient for me to feel comfortable recommending an isolated amino acid, particularly because some parents of kids on the autistic spectrum speculate that l-glutamine, in some kids, worsens their symptoms. Prior to conception, however, no problem. Best wishes,

  5. My sister is having acid reflex so bad she has to sleep sitting up. Doctors are experimenting with different drugs but nothing seem to work. Everything else seems good , she’s happy, recently lost a good bit of weight and stopped smoking after 50 years!!!!! She plays tennis now, and when she would get the erge to smoke she told me she would go for a swim or bike ride . I hate to see this acid reflux get her down because it inter fears with her rest, any suggestion? Should she try gluten free?

    • Either thru a functional medicine, integrative medicine, or naturopathic physician. There are also some labs that allow you to order your own. SIBO can be tested by your conventional doctor, and even leaky gut can be too, through a lactulose – mannitol test.

      • What is he NAME of the test that conventional doctors use to test for SIBO? I want to ask my doctor to test me. Thank you very much for the post!

  6. Do I have to eliminate coffee? I just cant seem to get off of it and I know for a fact I have leaky gut. My issue is I am so tired from the leaky gut but the coffee gives me energy for a small amount of time.

    • i am curious if its coffee (as in, the various properties in the roasted bean), or the caffeine that is aggravating your leaky gut. I don’t know this answer myself. However I just purchased Liquid Caffeine (website has that name) and while usually I am incredibly sensitive to caffeine and experience shakes, etc on very little, with the Liquid Caffeine I don’t. This makes me wonder if it’s not all of the other factors and ingredients in the various caffeinated sources that do the most harm rather than the caffeine.

      • I like coffee but it gives me acid reflux/GERD and makes me shaky. I am going to try the liquid caffeine and see if it works for me. What is the name of it? the website did’t show up on the post. Thank you

  7. I have hives or urticara. Habve been told it is autoimmune . Since it is long term. What would you suggest. Have jus been told to take antihistamines or try steroids???

    • Hi Annie, This can be caused by any number of things from an allergic reaction to a histamine intolerance problem. I would recommend seeing a functional medicine practitioner who is knowledgeable about these issues. See the Institute for Functional Medicine for possible providers. I’ve had some great results in my patients! Best, Aviva Romm

  8. Im currently on month 3 of the Cowden Protocol for Late Stage Lymes Disease. Could I take all these supplements while on this program?

  9. I have candida and can’t seem to take the probiotics because they throw me into a severe die off with headaches and vomiting. I have been experiencing this for almost four years now. I have been known to put plain organic yogurt in my smoothie, but not too much. And then I have been trying to bake cabbage which I understand has probiotics in it. I have been doing Diflucan once a week for two months and it seems to be lowering the severity of the die off thankfully. I just started aloe last week which I think is helping the stress level that the candida creates in me. Any other thoughts about how to get probiotics without such extreme die off?

    • Any time you experience a die off or a detox symptom, it’s best to back off to 1/2 of what you’re taking. Give your body time to adjust to it. Just a thought.

  10. I tried this, didn’t work, why? because I didn’t address the actual CAUSE of Leaky gut syndrome: GALLSTONES. So, I started getting my gallstones out naturally with a home cleanse. It’s WORKING. Done 80 now…. I don’t think anyone can have LGS without a physical digestion blockage (gallstones) That’s the whole reason the digestion has become stagnant in the first place. Without the stagnation(gallstones) no leaky gut.
    My LGS haven’t healed at all, and it doesn’t seem to before all gallstones are out. Going on 600+ passed stones now. They are mostly in the LIVER, not the gallbladder. And they are NOT detected on ultra sound and other scans if they’re not calcified (hardened, chalked) So often overlooked in young people that haven’t carried them a whole lifetime, which is something older folks have…. Then the stones have had time to harden.

    No one is talking about this, and it seems that nobody knows. It’s not common knowledge and this is not taught anywhere.

    • How are you getting rid of the gallstones? I’ve read of one protocol but it seems hard on the body. How do you feel during the cleanse and how do you do it? Very interested because I’m concerned I may have a gallstones. Thanks

    • Could you please share what protocol you are using for getting rid of stones?
      I have 5 year old child that is very toxic due to shots of Rocephin a very potent antibiotic. She has had many CNS and Stomach symptoms too many to list here after the Rocephin shot.
      I have consulted with a naturopath and she prescribed a detox protocol that include herbal drops. however, I feel her gut needs to be cleansed first before we try to get the toxins out. Any body have suggestions as to how to clean the gut on a child, liver stones on a child? Thank you

      • Hi Sue,

        My name is Megan and I am Aviva’s executive assistant. This can be tricky as you know, Aviva takes a deep dive into a gut healing protocol in her Healthy All Year Courses, but the specifics of what your little one is not covered, just how to work with a gut healing protocol. I hope this is helpful and we are sending warm healing wishes your way!

        Megan- Aviva Romm’s Executive Assistant and Online Nutrition Expert

  11. Do you have any suggestions on a good children’s probiotic to take especially when on the elimination part of the diet? Many chewable probiotics have sorbitol and xylitol that are not good when removing sugars from ones diet.

  12. Hi.

    Very interested in leaky gut syndrome having seen this on Facebook. My husband has autoimmune disease in the form of alopecia universalus! 12 years ago all his hair fell out and his finger and toe nails broke down and faded away. His nails returned stronger and over the years he had hair in his nose and shaving is face. Fuzz on his head and hair on his legs and chest about 12 which was as before. then he got Ross River Virus and all the hair vanished again and nails began splitting. One year one, nails ok but totally hairless again. Any ideas?

  13. Dear Aviva, Gr8 info! keep up w/ur gd work! U didnt give an answer to the MSG question of glutamate (isnt this vitamin diff than MSG chemical additive?)

    Yes I am one of those women (post menopausal) who cant seem to lose the 30 extra pounds altho I am a health fanatic (herbs vits cleansing etc). My thyroid tends to be on low range – any tips for getting to my goal? I can do exercise but dont get the chance only 1x week (is that a major prob w/holding back my weight loss issue?). TY in advance for ur response ROSE

  14. You forgot one of the most common symptoms is people who are very underweight. They might be malabsorbing nutrients due to leaky gut!

  15. Wouldn’t it be best to test patients before recommending a treatment? There are a few intestinal permeability tests that can be done to determine gut leakiness.

    • Testing can be helpful when positive results come back — if accessible and affordable — but we see a lot of false negatives in our practice. So I often go for treating the person rather than the test results.

  16. Eliminate all GMO food. This is what is killing the gut bacteria to start. Eat only organic. Stay away from the glyphosate (Round Up) that is now routinely sprayed on all GMO crops (along with wheat and sugar cane before harvest). Also consider what your consuming with animal protein and what they are being fed.

  17. Hi Aviva! Loved meeting you at Wanderlust VT and I hope you’re doing well! I’m trying the elimination diet and I was wondering if you feel like eating miso is the exception to the “no soy” rule? I haven’t been able to find a miso without soy (I do normally avoid soy/tofu, but I have enjoyed miso soup at sushi restaurants etc.), so I’m wondering if the miso soup is OK (and actually good for me) because it’s a “healthy” fermented food?

  18. Hi Dr. Aviva! Do I need to finish my 4-6 weeks of antimicrobials (Candibactan BR, cat’s claw, Interfase Plus) before I begin probiotics? Seems like that would be contradictory to take them together. Thank you!

  19. My friend was asking me about his acne the other day. He is 32 y/o male. Has had acne since teens, predominantly on face, worse around chin and neck, has thick white coating on tongue, craving sweets all the time, drinks alcohol only on weekends, mostly beer, eats alot of carbohydrates with vegetables (steamed) at night with meat every night. Was thinking of putting him on this Elimination Diet which I think will be a challenge for him but needed to support his gut and liver and clear up his skin. He doesn’t complain of any digestive symptoms (no bloating / cramping ect), has asthma and the occasional eczema breakout so has an allergic picture. Any thoughts?

    • I think lactofermented foods are great to keep in — but other fermented foods, like vinegar, kombucha, and yeasty products — I usually recommend eliminating those.

  20. Hi Aviva, it seems hard to get NN’s Pro EFA Junior now. Is there a more current Nordic Naturals kids product you recommend, and are you intentionally recommending a formula with GLA/Omega 6? I always heard that we should not be increasing Omega 6 in our diet, but is this a particular kind you think is important? Thanks!

  21. I have PCOS, hypothyroidism, and believe I have Leaky Gut (LOTS of bowel and GI symptoms). I’m overwhelmed with the amount of supplements I should be taking and dietary changes. Any suggestions on a the most important supplements/changes to start with first?

  22. This is such a great article, so well articulated, thanks, Aviva! I think it’s very important to mention, though, that this process is complicated and patients thinking they may be suffering from LGS are served by seeing a trained, licensed professional to help with the process. There isn’t a catch all protocol that’s good for all people all the time and functional medicine practitioners know the ins and outs of it!

    • Hi Mari Jo,

      Aviva will be diving into this topic in her up and coming new Gut Replenish course so please stay tuned! If you are subscribed to the weekly email she sends to people who have already joined her list!

      Warm wishes,
      Megan-Aviva Romm’s Executive Assistant and Online Nutrition Expert

  23. This may be a dumb question, but do you take all of the supplements together or do you just choose one to take? Thanks!

    • Hi Kristin,

      There is never a dumb question and thank you so much for your comment! If you scroll through the comments you will see Aviva’s response to your question!

      Megan- Aviva Romm’s Executive Assistant and Online Nutrition Expert

  24. What would you say for dosages of the herbals? You gave dosages for everything else, but I’m curious how/when to take aloe, marshmallow, and DGL licorice. I’ve been on an elimination diet for several months now, and need more support for healing…

    • Hi Alicia,

      Stay tuned for an up and coming podcast where Aviva will be interviewing a fermentation expert!

      Megan- Aviva Romm’s Executive Assistant and Online Nutrition Expert

  25. How long are you supposed to wait between each stage? I know you said to do the elimination diet for 2 weeks, but then how long on Replace before Reinoculate, etc.? I have been doing the first three stages for a few weeks, but unsure of how long to wait before adding in the tumeric, aloe vera, marshmallow root, and DGL licorice. Thanks so much for you very informative website!

    • Hi Audrey,
      Often in my practice I do the steps somewhat simultaneously for the biggest bang for the buck. BUT you can do slim for a 2-4 weeks and then see what improvements you get just from removing the foods then add in the next phase once you see what symptoms you’re still having. The repair phase often lasts for several months. It also depends on the situation. For IBS where there isn’t a ton of inflammation, I might add in the herbs only after a few weeks on the first phase; but if there’s a lot of inflammation in your system, I’d get on the herbs from the get go. Delighted to help – glad you enjoy the website! Warmly, Aviva

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